Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), Lleida, Spain.
Institut Català de la Salut (ICS), Atenció Primària, Lleida, Spain.
J Cereb Blood Flow Metab. 2022 Dec;42(12):2201-2215. doi: 10.1177/0271678X221116288. Epub 2022 Jul 22.
Transient ischemic attacks (TIAs) before an acute ischemic stroke (AIS) could induce ischemic tolerance (IT) phenomena. with an endogenous neuroprotective role (Ischemic preconditioning. IPC). A consecutive prospective cohort of patients with AIS were recruited from 8 different hospitals. Participants were classified by those with non-previous recent TIA vs. previous TIA (within seven days. TIA ≤7d). A total of 541 AIS patients were recruited. 40 (7.4%). of them had previous TIA ≤7d. In line with IPC. patients with TIA ≤7d showed: 1) a significantly less severe stroke at admission by NIHSS score. 2) a better outcome at 7-90 days follow-up and reduced infarct volumes. 3) a specific upregulated metabolomics/lipidomic profile composed of diverse lipid categories. Effectively. IPC activates an additional adaptive response on increasing circulation levels of structural and bioactive lipids to facilitate functional recovery after AIS which may support biochemical machinery for neuronal survival. Furthermore. previous TIA before AIS seems to facilitate the production of anti-inflammatory mediators that contribute to a better immune response. Thus. the IT phenomena contributes to a better adaptation of further ischemia. Our study provides first-time evidence of a metabolomics/lipidomic signature related to the development of stroke tolerance in AIS patients induced by recent TIA.
短暂性脑缺血发作（TIA）在前急性缺血性脑卒中（AIS）可诱导缺血耐受（IT）现象。具有内源性神经保护作用（缺血预处理，IPC）。连续前瞻性队列研究招募了 8 家不同医院的 AIS 患者。参与者分为近期无 TIA 组与近期 TIA 组（7 天内，TIA≤7d）。共纳入 541 例 AIS 患者，其中 40 例（7.4%）TIA≤7d。与 IPC 一致，TIA≤7d 患者：1）入院时 NIHSS 评分的卒中严重程度显著降低；2）7-90 天随访时的结局更好，梗死体积更小；3）特定的代谢组学/脂质组学谱上调，由多种脂质类别组成。有效，IPC 通过增加结构和生物活性脂质的循环水平来激活额外的适应性反应，以促进 AIS 后的功能恢复，这可能支持神经元存活的生化机制。此外，AIS 前的近期 TIA 似乎促进了抗炎介质的产生，有助于更好的免疫反应。因此，IT 现象有助于进一步缺血的更好适应。本研究首次提供了与近期 TIA 诱导的 AIS 患者卒中耐受发展相关的代谢组学/脂质组学特征的证据。
